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meters and RF radiation exposure This is only a sample and is not intended to substitute for legal advice. [DATE] [NAME OF PUBLIC UTILITY COMMISSION] [ADDRESS] [NAME OF UTILITY] [ADDRESS] UTILITY CUSTOMER ACCOUNT # Re: Reasonable Accommodation for my disability / disabilities/ medical condition[s] Dear [PUBLIC UTILITY COMMISSION ADA COORDINATOR] [UTILITY MANAGER]: I am a customer of your utility [NAME OF UTILITY]. I live at [ADDRESS] and have lived there since [DATE]. I am a qualified individual with a disability / medical condition [disabilities and multiple medical conditions] as defined by the Fair Housing Amendments Act of 1988, the Americans with Disabilities Act, and Section 504, Title 10, as well as other related state and federal discrimination laws. My residence received [a gas and] an electric smart meter on or about [DATE]. [Both of these] This meter[s] emit[s] RF radiation, which aggravates my existing medical conditions and disability. Because of my disability [ies], I request the following accommodations: [LIST ACCOMMODATIONS, INCLUDE: REMOVAL OF SMART METER, REPLACEMENT WITH SOLELY ELECTROMECHANICAL (ANALOG) METER AT NO CHARGE; REMOVAL OF OTHER SMART METERS SURROUNDING RESIDENCE AT A DISTANCE OF ____ FEET, AT NO CHARGE]. A medical provider has prescribed this accommodation for my disability / medical condition. [ATTACH LETTER.] I request these accommodations that will enable me to have an equal opportunity to live in and enjoy my residence and receive full access to gas and electric services with out RF radiation exposure. I request that the smart meter "opt-out" to analog
meter (electromechanical-only) be part of the accommodation, without charging fees or extra costs for the accommodation, which are not allowable under the above-mentioned discrimination laws. Please let me know what, if any, additional information you need from my health care provider in order to better understand my disability [ies] and/or medical conditions pertaining to this request, and the limitations it [they] impose [s]. Under the Fair Housing Amendments Act and/or Title III of the Americans with Disabilities Act, and Section 504 of the Rehabilitation Act of 1973, and Title 10, in addition to other state and federal laws against discrimination, it is unlawful discrimination to deny a person with a disability a reasonable accommodation of policies, procedures, and activities, where necessary to avoid discrimination if such accommodation may be necessary to afford such person full enjoyment of the premises or equal access and/or participation in programs and services. Please keep this request for accommodation confidential, as required by federal law. Please contact me within the next ten days to discuss this important issue. I look forward to your response in writing and appreciate your prompt attention to this matter. Sincerely, Signature Printed Name Address w/ zip code Phone number email address Cc: Attachments (list them)